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PubMed1989

Proper use of aerosol corticosteroids to control asthma.

Aerosol glucocorticoids are highly effective in the treatment of bronchial asthma. Clinically apparent systemic hypercortisolism is virtually nonexistent in patients who receive such therapy, although local effects of candidiasis or dysphonia may occur. Treatment failures can often be attributed to poor patient compliance or incorrect use of the pressurized aerosol inhaler. The addition of a spacer device to the inhaler improves the technique and the results in many patients. Furthermore, many patients with asthma require 2 or 3 times the conventional dose of aerosol corticosteroids for optimal control of pulmonary function. Careful coaching is essential for the successful use of aerosol corticosteroids.

Administration, Inhalation↗
PubMed2003

Marine sulfur cycling and the atmospheric aerosol over the springtime North Atlantic.

We investigated the distribution of phytoplankton species and the associated dimethyl sulfur species, dimethylsulfoniopropionate (DMSP) and dimethylsulfide (DMS) on a cruise into the spring bloom region of the northern North Atlantic (near 47 degrees N, 19 degrees W). The cruise was timed to characterize the relationship between plankton dynamics and sulfur species production during the spring plankton bloom period. At the same time, we measured the DMS concentrations in the atmospheric boundary layer and determined the abundance and composition of the atmospheric aerosol. The water column studies showed that the interplay of wind-driven mixing and stratification due to solar heating controlled the evolution of the plankton population, and consequently the abundance of particulate and dissolved DMSP and DMS. The sea-to-air transfer of DMS was modulated by strong variations in wind speed, and was found to be consistent with currently available transfer parameterizations. The atmospheric concentration of DMS was strongly dependent on the sea surface emission, the depth of the atmospheric boundary layer and the rate of photooxidation as inferred from UV irradiance. Sea-salt and anthropogenic sulfate were the most abundant components of the atmospheric aerosol. On two days, a strong dust episode was observed bringing mineral dust aerosol from the Sahara desert to our northerly study region. The background concentrations of marine biogenic sulfate aerosol were low, near 30-60 ppt. These values were consistent with the rate of sulfate production estimated from the abundance of DMS in the marine boundary layer.

Aerosols↗
PubMed2000

The effect of large anthropogenic particulate emissions on atmospheric aerosols, deposition and bioindicators in the eastern Gulf of Finland region.

The effect of the emissions from large oil shale fuelled power plants and a cement factory in Estonia on the elemental concentration of atmospheric aerosols, deposition, elemental composition of mosses and ecological effects on mosses, lichens and pine trees in the eastern Gulf of Finland region has been studied. In addition to chemical analysis, fly ash, moss and aerosol samples were analysed by a scanning electron microscope with an energy dispersive X-ray spectrometer (SEM/EDS). The massive particulate calcium emissions, approximately 60 kton/year (1992), is clearly observed in the aerosols, deposition and mosses. The calcium deposition is largest next to the Russian border downwind from the power plants and in south-eastern part of Finland. This deposition has decreased due to the application of dust removal systems at the particulate emission sources. At the Virolahti EMEP station approximately 140 km north from the emission sources, elevated elemental atmospheric aerosol concentrations are observed for Al, Ca, Fe, K and Si and during episodes many trace elements, such as As, Br, Mo, Ni, Pb and V. The acidification of the soil is negligible because of the high content of basic cations in the deposition. Visible symptoms on pine trees are negligible. However, in moss samples close to the power plants, up to 25% of the leaf surface was covered by particles. Many epiphytic lichen species do not tolerate basic stemflow and on the other hand most species are also very sensitive for the SO2 content in air. Consequently a large lichen desert is found in an area of 2500 km2 in the vicinity of the power plants with only one out of the investigated 12 species growing.

Aerosols↗
PubMed1998

Atmospheric metal pollution (Cr, Cu, Fe, Mn, Ni, Pb and Zn) in Oporto city derived from results for low-volume aerosol samplers and for the moss Sphagnum auriculatum bioindicator.

A low-volume aerosol sampler with filters and bags of Sphagnum auriculatum were exposed, in parallel, to the atmosphere of Oporto city for approx. 2 months in 1994, during a dry weather period. The levels of Cr, Cu, Fe, Mn, Ni, Pb and Zn in the moss (weekly samples) and in the filters (daily samples) were determined by atomic absorption spectrophotometry and the results were compared. For all the heavy metals, the rate of metal uptake by moss was significantly correlated with the metal concentration in atmospheric aerosols. The results indicated that moss bags of S. auriculatum can provide a quantitative estimation of the concentration of different heavy metals in urban atmospheres, when specific calibration by mechanic monitoring, at the same sampling point, is performed during a first stage of biomonitoring. The mean aerosol metal concentrations found in the Oporto atmosphere were similar to those observed in other urban atmospheres in different countries. The relative order of the mean metal concentrations was Fe (1.8 micrograms/m3) > Zn > Pb > Cu > Cr > Mn > Ni (20 ng/m3). The aerosol Pb levels were monitored at different sampling points over various periods of time between 1991 and 1997. The mean Pb levels were < or = 0.5 microgram/m3 and approximately constant at each sample point up to January 1996. After that date it decreased by approx. 50%, in consequence of the reduction of the Pb concentration in leaded gasoline.

Aerosols↗
PubMed1998

Correlation between urinary 1-hydroxypyrene and ambient air pyrene measured with an inhalable aerosol sampler and a total dust sampler in an electrode paste plant.

The aim of this study was to investigate whether the use of an inhalable aerosol sampler would improve the correlation between urinary 1-hydroxypyrene and occupational pyrene exposure compared to measurements with a total dust sampler in an electrode paste plant. PAHs were collected on a filter and adsorbent by a 37-mm closed-face total aerosol sampler and an open-face sampler for inhalable aerosol from the Institute of Occupational Medicine (IOM). 1-Hydroxypyrene in pre- and post-shift urine samples was quantitated by high performance liquid chromatography (HPLC). In this study, the use of the IOM sampler resulted in approximately four times higher concentrations of particulate PAH and pyrene than the total dust sampler. The correlation between pyrene levels measured with the two samplers was good with a correlation coefficient of 0.83. The correlation between workplace air pyrene and 1-hydroxypyrene in post-shift urine was poor (r = -0.12), but a small non-significant improvement was found with the IOM sampler (r = 0.11). In this factory the use of an inhalable aerosol sampler had only marginal effect on the correlation between 1-hydroxypyrene in urine and breathing zone pyrene. These results indicate that skin exposure is an important route of PAH uptake in this plant.

Adult↗
PubMed1997

A comparison of triamcinolone acetonide nasal aerosol spray and fluticasone propionate aqueous solution spray in the treatment of spring allergic rhinitis.

BACKGROUND: Many nasal corticosteroids with different potencies and formulations are available, but they have all been proven safe and effective. The clinical relevance, if any, of these differences is not yet completely established. OBJECTIVE: We sought to compare the efficacy, safety, and patients' acceptance of triamcinolone acetonide aerosol spray and fluticasone propionate aqueous solution in the treatment of spring allergic rhinitis. METHODS: After a drug-free baseline evaluation, patients with rhinitis were randomized to receive either a triamcinolone aerosol spray of 110 microg in each nostril once daily (n = 117) or a fluticasone solution spray of 100 microg in each nostril once daily (n = 116) in a single-blind, parallel-group study. The Rhinitis Index Score (sum of scores of symptoms on a scale from 0 to 3) was evaluated daily, in the morning before drug administration, for 21 days. The efficacy of each treatment was assessed by the mean reduction from baseline in the Rhinitis Index Score and in individual symptom scores. Patients' acceptance of the study drugs was also monitored by a daily questionnaire. RESULTS: Reductions of the Rhinitis Index Score (mean +/- SEM) were 4.20 +/- 0.21 and 4.60 +/- 0.21 for triamcinolone and fluticasone, respectively (p = 0.23). There were no statistically significant differences between the drugs in the reduction of any of the individual symptoms. Patients expressed statistically significant differences between the drugs regarding acceptance; different properties of the aerosol and the solution were appreciated differently. CONCLUSIONS: This study shows that triamcinolone acetonide aerosol and fluticasone propionate solution sprays are both clinically equally effective, safe, and well tolerated for the treatment of spring pollen allergic rhinitis.

Administration, Inhalation↗
PubMed1989

Prevention of Pneumocystis carinii pneumonia relapse by pentamidine aerosol in zidovudine-treated AIDS patients.

To examine the efficacy and tolerance of pentamidine aerosol in the prevention of Pneumocystis carinii pneumonia (PCP) relapse in patients with the acquired immunodeficiency syndrome (AIDS) being treated with zidovudine, 51 patients who had had an episode of PCP in the previous 5 months were enrolled in a randomised controlled study. 25 patients (group I) received pentamidine mesylate aerosol (4 mg/kg every 2 weeks for the first month then monthly) and zidovudine, and 26 patients (group II) zidovudine alone. 3 group I patients withdrew from pentamidine therapy prematurely and were excluded from the analysis of efficacy. Relapses of PCP occurred in 2 out of 22 (9%) group I patients and in 16 out of 26 (61%) group II patients after a mean follow-up of 10 and 8.7 months, respectively. The two groups differed significantly (p less than 0.0001) in proportions without relapse. They did not differ in proportions surviving. Bronchial intolerance was common (47%); no systemic side-effects of pentamidine were observed. Pentamidine aerosol thus seems to be effective in preventing PCP relapses in AIDS patients on zidovudine. The early termination of the trial prevented assessment of the long-term efficacy and safety of pentamidine given by aerosol.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Early changes in the phenotypic composition of lymphocytes in the bronchoalveolar lavage of pigs after aerogenic immunization with Pasteurella multocida aerosols.

The phenotypic composition of bronchoalveolar lymphocytes (BALL) of healthy untreated pigs and of pigs immunized via aerosol with a live Pasteurella multocida mutant was measured cytofluorometrically in comparison to blood lymphocytes (PBL). Cells were analyzed using monoclonal antibodies against porcine IgM, IgA, IgG and SWC3 in single-colour fluorescence and the following antibody combinations for two-colour fluorescence: CD2/SWC1, SWC1/CD25 and CD4/CD8. In nonimmunized pigs, differences between lymphocyte subsets derived from blood and lung were obvious. The numbers of CD2-SWC1+ T-cells, CD25+ activated lymphocytes and IgG+ cells were significantly higher in the bronchoalveolar compartment. Aerosol immunization with P. multocida caused only insignificant changes in the phenotypic composition of PBL whereas the composition of lung-derived lymphocytes changed markedly. The percentage of CD2-SWC1+ lymphocytes and of CD25+ cells coexpressing the SWC1 antigen in BALL increased up to 10 days after aerosol administration, whereas the percentage of all Ig+ cells decreased. These data reflect an early cellular reaction to an aerogenic immunization with a P. multocida aerosol, characterized by an increase in CD2+ T-cells and a T-cell activation.

Aerosols↗
PubMed2001

Influence of formulation excipients and physical characteristics of inhalation dry powders on their aerosolization performance.

The objective of this study was to determine the effects of formulation excipients and physical characteristics of inhalation particles on their in vitro aerosolization performance, and thereby to maximize their respirable fraction. Dry powders were produced by spray-drying using excipients that are FDA-approved for inhalation as lactose, materials that are endogenous to the lungs as albumin and dipalmitoylphosphatidylcholine (DPPC); and/or protein stabilizers as trehalose or mannitol. Dry powders suitable for deep lung deposition, i.e. with an aerodynamic diameter of individual particles <3 microm, were prepared. They presented 0.04--0.25 g/cm(3) bulk tap densities, 3--5 microm geometric particle sizes, up to 90% emitted doses and 50% respirable fractions in the Andersen cascade impactor using a Spinhaler inhaler device. The incorporation of lactose, albumin and DPPC in the formulation all improved the aerosolization properties, in contrast to trehalose and the mannitol which decreased powder flowability. The relative proportion of the excipients affected aerosol performance as well. The lower the bulk powder tap density, the higher the respirable fraction. Optimization of in vitro aerosolization properties of inhalation dry powders can be achieved by appropriately selecting composition and physical characteristics of the particles.

Administration, Inhalation↗
PubMed1981

Aerosol vs injected epinephrine in acute asthma.

Twenty-five patients with acute asthma were randomized prospectively into one of two double-blind treatment regimens: regimen 1 consisted of subcutaneous epinephrine combined with aerosol placebo; regimen 2 consisted of aerosol epinephrine with injected placebo. In patients with severe airway obstruction (peak expiratory flow rate less than 120, or less than 25% of predicted normal), parenteral epinephrine was superior to aerosol (P less than 0.005) at the end of one hour. However, in patients with mild to moderate asthma (PEFR greater than 120), injected and inhaled epinephrine were of equal efficacy, with the aerosol producing fewer side effects (P less than 0.001).

Adolescent↗
PubMed1995

Treatment of acute bronchospasm with beta-adrenergic agonist aerosols delivered by a nasal bilevel positive airway pressure circuit.

STUDY OBJECTIVE: To determine whether beta-adrenergic agonist aerosols are more effective in treating acute bronchospasm if delivered by nasal bilevel positive airway pressure (BiPAP) than by a small-volume nebulizer (SVN). We hypothesized that BiPAP would reduce the work of breathing in asthmatic patients and thereby hasten improvement of bronchospasm from beta-agonist therapy. Previous trials with aerosols given by intermittent positive-pressure breathing were unrewarding, but BiPAP is unique in that inspiratory (IPAP) and expiratory (EPAP) support pressures may be set separately. DESIGN: Convenience-randomized prospective clinical study. SETTING: Emergency department of an urban tertiary care teaching hospital. PARTICIPANTS: Afebrile, wheezing patients between 18 and 40 years of age. INTERVENTIONS: Patients were randomly assigned to receive two doses of aerosolized albuterol (2.5 mg in 3 mL normal saline solution), 20 minutes apart, delivered by either SVN (n = 40) or BiPAP (n = 60) by nosemask or facemask (IPAP, 10 cm H2O; EPAP, 5 cm H2O). RESULTS: Peak expiratory flow rate (PEFR), arterial blood oxygen saturation (by pulse oximetry), and pulse and respiratory rates were measured at baseline and after each treatment. The two treatment groups had similar values for pulse oximetry, pulse rate, respiratory rate, and percent of predicted peak expiratory flow rate (%PPEFR) at entry, and all patients experienced similar changes in the first three of these variables through the course of treatment. BiPAP patients had a significantly greater increase in %PPEFR after each treatment (P = .0011) and from baseline to completion (P = .0013). Increase in absolute PEFR was greater in the BiPAP group (from 211 +/- 89 [mean +/- SD] to 357 +/- 108 L/minute for BiPAP, from 183 +/- 60 to 280 +/- 87 L/minute for SVN; P = .0001). CONCLUSION: In this population, response to initial ED management of bronchospasm, as measured by PEFR, was better with aerosols delivered by BiPAP than with those delivered by SVN.

Acute Disease↗
PubMed2002

A randomized trial demonstrating successful boosting responses following simultaneous aerosols of measles and rubella (MR) vaccines in school age children.

The reactogenicity and immunogenicity of combined measles and rubella (MR) booster vaccination, via aerosol and subcutaneous routes, was assessed in 562 healthy children. Rates of rubella seroconversion and geometric mean titers (GMT) were similar for both routes. Rates of measles PN seroconversion, GMT and measles ELISA post-vaccination seropositivity and seroconversion rate were each higher for aerosol vaccine (54%, 3928 IU/l, 99.6 and 98.8%), than for subcutaneous vaccine (7%, 866 IU/l, 92.2 and 82.4%) (P<0.01). Reactogenicity was higher for subcutaneous vaccine (P<0.05). This study demonstrates that aerosol vaccine was more immunogenic for measles antibodies, and equally immunogenic for rubella antibodies. Aerosol vaccine was less reactogenic.

Aerosols↗
PubMed1998

Induction of protective immune responses against Venezuelan equine encephalitis (VEE) virus aerosol challenge with microencapsulated VEE virus vaccine.

Venezuelan equine encephalomyelitis (VEE) virus, a member of the family Togaviridae, genus Alphavirus, causes disease in humans and equids. The virus is normally transmitted by the bite of an infected mosquito however, it can also be highly infectious by aerosol. The purpose of the present study was to determine the effectiveness of formalin-fixed, 60Co-irradiated VEE virus microencapsulated in poly DL-lactide-co-glycolide in inducing immune responses protective against aerosol challenge with virulent VEE virus. Balb/c mice were primed by subcutaneous injection of microencapsulated VEE virus vaccine, followed 30 days later by a single immunization with the same vaccine given via the oral, intratracheal (i.t.) or subcutaneous (s.c.) route. Mice boosted by the i.t. or s.c. route had higher plasma IgG anti-VEE virus levels than orally immunized animals. The responses in the former groups were similar in magnitude to those seen in mice primed and boosted by the i.t. route. Antibody activity was detected in bronchial-alveolar and intestinal washes, fecal extracts and saliva from immunized animals. The levels of IgG and IgA antibody activity in bronchial-alveolar wash fluids from mice boosted by the i.t. route were higher than those seen in animals immunized by the oral or s.c. route with the microsphere vaccine. Mice immunized with the microencapsulated VEE virus vaccine were protected from lethal VEE virus infection following aerosol challenge at approximately three months after the initial immunization. Mucosal immunization via the i.t. route appeared to be the most effective regimen, since 100% of the mice resisted aerosol challenge.

Administration, Inhalation↗
PubMed2003

The use of aerosol formation, flammability, and explosion information for heat-transfer fluid selection.

The devastating consequences of aerosol/mist explosions have been widely documented, and there are currently efforts to understand the mechanisms of formation and explosion of aerosols. Heat-transfer fluids (HTFs) are particularly susceptible to these hazards, because they are utilized under high pressures and below their flash points, making them more prone to leaking as aerosols. In fact, there is a critical need during design stages for a perception of explosion risks associated with the selection of HTFs. This paper discusses a novel scheme to integrate the knowledge of HTF aerosol formation from leaks in process equipment into the selection of HTFs during the design process. Hazards of aerosols formed from leaks are classified qualitatively using process pressure and droplet sizes.

Aerosols↗
PubMed2000

A comparison of the acute hemodynamic effects of inhaled nitric oxide and aerosolized iloprost in primary pulmonary hypertension. German PPH study group.

OBJECTIVE: We sought to compare the acute hemodynamic effects of inhaled nitric oxide (NO) and aerosolized iloprost in primary pulmonary hypertension (PPH). BACKGROUND: Inhalation of the stable prostacyclin analogue iloprost has recently been described as a novel therapeutic strategy for PPH and may offer an alternative to continuous intravenous infusion of prostacyclin or inhalation of NO. METHODS: During right heart catheterization, 35 patients with PPH sequentially inhaled 40 ppm of NO and 14 to 17 microg of iloprost, and the effects on hemodynamics and blood gases were monitored. RESULTS: Both NO and iloprost caused significant increases in cardiac output, mixed-venous oxygen saturation and stroke volume as well as significant decreases in pulmonary artery pressure and pulmonary vascular resistance, whereas only inhaled iloprost significantly increased the arterial PO2 (p = 0.01). Compared with inhaled NO, aerosolized iloprost was more effective in reducing pulmonary artery pressure (-8.3 +/- 7.5 mm Hg vs. -4.3 +/- 8.8 mm Hg; p = 0.0001) and the pulmonary vascular resistance (-447 +/- 340 dynes x s x cm(-5) vs. -183 +/- 305 dyne x s x cm(-5); p < 0.0001). Furthermore, aerosolized iloprost caused a significantly greater increase of the cardiac output compared with NO (+0.7 +/- 0.6 liter/min vs. +0.3 +/- 0.4 liter/min; p = 0.0002) and had a more pronounced effect on the mixed-venous oxygen saturation (p = 0.003). CONCLUSIONS: During acute drug testing, aerosolized iloprost was more potent than inhaled NO as a pulmonary vasodilator in PPH at the doses used in this study.

Administration, Inhalation↗
PubMed2002

In vitro deposition of fluticasone aerosol from a metered-dose inhaler with and without two common valved holding chambers.

BACKGROUND: Previous in vitro aerosol deposition experiments indicate that the corticosteroid respirable dose from a metered-dose inhaler (MDI) can vary by threefold depending on the specific valved holding chamber (VHC) MDI combination. OBJECTIVE: We compared in vitro aerosol deposition from a fluticasone propionate MDI (Flovent, GlaxoSmithKline, Research Triangle Park, NC) to that of the same MDI used in combination with two VHCs (EasiVent, Dey, Napa, Ca; and AeroChamber-Plus, Monaghan Medical Corp, Plattsburgh, NY) to evaluate how these VHCs affect the respirable dose of fluticasone. METHODS: The respirable dose (aerosol particles 1 to 5 microm in size) of fluticasone was determined by sampling 5 x 110-microg actuations from each configuration (MDI alone, MDI plus AeroChamber-Plus, and MDI plus EasiVent) in multiples of ten using a well established, in vitro cascade impactor method. Fluticasone aerosol was washed from individual impactor stages with 50% methanol and quantified via ultraviolet high-pressure liquid chromatography. Differences among outcomes were determined using analysis of variance. RESULTS: Mean respirable dose from AeroChamber-Plus (47.9 +/- 6.9 microg/actuation) was not different (P > 0.05) from that produced by the MDI alone (50.3 +/- 2.2 microg/actuation). EasiVent respirable dose (27.0 +/- 3.6 microg/actuation) was less than that produced by either the AeroChamber-Plus or the MDI alone (P < 0.001). CONCLUSIONS: VHCs do not display equivalent in vitro performance with a fluticasone MDI. If a patient needs a VHC, clinicians should use available in vitro performance information to aid in selecting the best device.

Aerosols↗
PubMed2000

Comparison of powder and aerosol formulations of salmeterol in the treatment of asthma.

BACKGROUND: The efficacy and safety of the aerosol metered-dose inhaler (MDI) formulation of salmeterol for asthma symptoms have been established. Recently, salmeterol has been introduced as a micronized powder formulation administered via a breath-activated multidose powder inhaler (Diskus). OBJECTIVE: A multicenter, randomized, double-blind, double-dummy, parallel-group, placebo-controlled study involving 498 adolescents and adults with mild-to-moderate asthma was conducted to compare the efficacy and safety of salmeterol powder 50 microg twice daily via Diskus, salmeterol aerosol 42 microg twice daily via MDI, and placebo. METHODS: Patients were randomized to one of the three treatment groups for 12 weeks. Efficacy was assessed by serial measurements of forced expiratory volume in one second (FEV1) over 12 hours, daily peak expiratory flow (PEF), self-rated asthma symptom scores, nighttime awakenings, and supplemental albuterol use. Safety of each treatment was evaluated by monitoring vital signs, electrocardiograms, Holter monitoring, and occurrence of adverse events. RESULTS: As compared with placebo, both salmeterol powder and aerosol produced significant improvement in FEV1 and PEF and decreased nighttime awakenings and supplemental albuterol use. There were no significant differences in the efficacy of the two salmeterol formulations. The magnitude of improvement in pulmonary function was undiminished over the 12-week study. Both formulations of salmeterol were well tolerated, with safety profiles not significantly different from placebo. CONCLUSION: Results of this study indicate that salmeterol, administered either as a powder 50 microg twice daily via Diskus or as an aerosol 42 microg twice daily via MDI, produces clinically significant and comparable improvement in pulmonary function and is well tolerated in patients with mild-to-moderate persistent asthma.

Adolescent↗
PubMed2003

Biodistribution and pharmacokinetics of aerosol and intravenously administered DNA-polyethyleneimine complexes: optimization of pulmonary delivery and retention.

This report describes the time-dependent biodistribution of human p53 plasmid delivered in aerosol with polyethyleneimine in mice compared to the distribution of this material following intravenous injection. Area-under-the-curve values for p53 plasmid after inhalation were 2.8-fold greater than values after intravenous administration, despite the fact that the delivered aerosol dose was one-fifth the intravenous dose. After aerosol administration, pulmonary concentrations of p53 plasmid were high and other organs showed amounts not distinguishable from untreated control. High concentrations of p53 plasmid in the lungs remained with negligible reduction for at least 24 h. Shortly after intravenous injection, organs exhibited the following relative levels of exogenously administered p53: liver > spleen > blood > or = lungs > heart > kidney. These results demonstrate effective pulmonary delivery of DNA in complex with PEI by aerosol, without significant systemic dissemination. In contrast, intravenous administration caused a prompt systemic distribution of DNA with a shorter half-life of the administered gene in the lungs.

Administration, Inhalation↗